Nurses' experiences of the family's role in end-of-life care.

Background: Family units can be deeply affected and require nurses' attention and care when their loved ones reach the end-of-life stage. However, the role of the family in end-of-life nursing is under-researched in a tertiary hospital setting. Aim: This study aims to explore and describe nurses' lived experiences of the family's role in end-of-life care at a tertiary hospital in the Western Cape. Setting: The study took place in a tertiary hospital in the Western Cape. Methods: A qualitative hermeneutic design with a phenomenological approach was used. Ten professional nurses were interviewed in person, and two focus groups comprised enrolled and auxiliary nurses (11) with a minimum of 6 months of experience in end-of-life care. Data analysis was conducted by categorising qualitative information into codes and themes, following Creswell's outlined methodology. Results: Three themes emerged: emotional challenges associated with families of end-of-life patients, strategies that assist families and impediments to providing care. Participants experienced challenges managing strong emotions expressed by families and their own, but provided care regardless. Strategies that have been found to be helpful to families include communication, access, and involving them in patient care. Participants experienced the need for emotional support and specialised end-of-life training. Conclusion: Participants strive to provide understanding and support to families despite challenges, but emotional and end-of-life training resources are required to equip nurses to address patients' and families' needs competently. Contribution: This study adds the nurses' experience and understanding of the family's role in providing end-of-life care in a tertiary hospital.

Early marriage, education and mental health: experiences of adolescent girls in Mozambique.

Introduction and background: Early marriage and maternity represent a violation of human rights and a barrier to achieving gender equality in education. Studies conducted across various regions and countries, including Mozambique, have highlighted the negative consequences of early marriage and maternity, particularly on adolescent girls' physical, educational and mental health. Adolescent girls who marry before the age of 18 are more prone to a broad spectrum of mood, anxiety, and other psychiatric disorders. In the districts of Maganja da Costa and Morrumbala in Zambézia Province, Mozambique, high rates of early marriage persist despite government policies and interventions. Purpose statement: This study aims to understand early marriage's socio-cultural, economic, and psychological drivers and impacts on adolescent girls' lives, focusing on education, mental health, and well-being. Design and methods: This paper used a qualitative research design. We employed a life-story approach and used purposeful sampling to identify participants. Semi-structured interviews were conducted with 25 participants and the data were analysed using Tesch's thematic analysis approach. Results: Elements contributing to early marriage and pregnancy are intricately linked with socio-cultural elements. These include the induction into specific societal roles, the affirmation of childbearing, the perceived importance of dowry, the impact of rite-of-passage ceremonies, and the cultural significance associated with a girl's initial menstruation. School dropout often originates from geographical and transportation challenges, nudging adolescent girls towards early marriage. In some instances, termination of pregnancy was viewed as a solution, while engaging in sexual activities was seen as a means to inject purpose into their lives or as a response to poverty. Positive changes and emotions were evident, yet regrettably, the ramifications of early pregnancy and marriage were primarily detrimental. These influenced the adolescent girls' interpersonal connections, educational and career opportunities, emotional well-being, and access to support networks. Conclusions: The modern perspective, which advocates for equal educational rights for boys and girls and posits that marriage should occur after the age of 18, contradicts the socio-cultural perspective of adulthood. Contribution: This study adds to the ongoing efforts to prevent and combat early marriage and maternity in Africa.

Registered nurses' management of depression in general wards.

Background: During and in the aftermath of the COVID-19, the rate of depression increased globally. A significant number of patients found in a general hospital or ward with physical conditions often have depression. Aim: This study aimed to gain an in-depth understanding of registered nurses' experiences managing patients with depression in a general medical ward. Setting: The study took place in two general medical wards of a private hospital in the Gauteng province, South Africa, in 2021, with COVID-19 lockdown levels three to one prevailing. Methods: A descriptive qualitative design was used, and data were collected through 10 in-depth, face-to-face interviews. Data were analysed using a thematic approach. Results: The COVID-19 pandemic exerted a bidirectional influence, affecting both patients diagnosed with depression while admitted to a general ward and the nurses caring for them. This mutual impact added an additional layer of complexity to patient management. Conclusion: For optimal care of patients with depression in general wards, nurses need comprehensive training, confidence and a safe environment, bolstered by sufficient resources and robust management support. Contribution: The study highlights critical challenges in detecting and caring for patients diagnosed with depression in a general medical ward and the compounding effect of COVID-19. These findings underscore the importance of addressing clinical and psychosocial needs in a healthcare setting, especially amid a global pandemic.

Exploratory factor analysis of constructs used for investigating research uptake for public healthcare practice and policy in a resource-limited setting, South Africa.

BACKGROUND: Low-resource settings are often less capable of responding to and implementing available quality research evidence for public healthcare practice and policy development due to various factors. In most low-resource settings, limited empirical evidence is available to help deal with localised factors that contribute to low public health research uptake, particularly from the perspective of key research stakeholders. METHODS: Although the study initially employed a two-phase exploratory sequential approach, this paper focuses on the results generated from a quantitative approach. Considering the determining factors that affect research uptake in the context of low-resource settings, a measuring instrument was developed and its reliability and validity were assessed using an exploratory factor analysis approach. RESULTS: A total of 212 respondents, according to their job roles and titles, were identified as researchers, front-line workers, programme managers, and directors/senior managers of higher learning institutions, indicating that the three constructs applied in the questionnaire, namely (1) individual factors, (2) organisational factors, and (3) research characteristics, demonstrated relatively high reliability with a Cronbach's alpha of greater than 0.791. CONCLUSION: The study concludes that the instrument can potentially be used to measure factors that affect research uptake in low-resource settings.

Early marriage and adolescent pregnancy in Mozambique.

Early marriage and adolescent pregnancies are prevailing phenomena in Mozambique, with 48% and 40% of girls aged 20-24 marrying and getting pregnant before the age of 18. Using a cross-sectional survey in Maganja da Costa and Morrumbala districts, Zambézia Province, and descriptive and inferential statistics for data analysis, the study revealed that around 65% of adolescent became pregnant at the age of 15-17. Among these adolescent, 18.8% had their first baby before turning 15 and 99.2% before their 18th birthday. Of the respondents, 23% experienced health complications after birth. A further 71.5% said they did not, and 5.5% were 'not applicable'. Referring to their education, 55.9% of adolescents finished primary education, 39.9% completed secondary education, and 2.9% achieved some higher education qualification. When asked if they were going to school while initially pregnant, 58.7% responded "yes", 39.7% responded "no," and 1.6% answered "not applicable" as they had never gone to school. After delivery, 31.6% returned to school, and 66.8% did not. This supports the assumption that early marriage and adolescent pregnancies are potential drivers for school dropout, low education and adverse pregnancy and birth health outcomes. Girls' education can act as a protective factor in delaying early marriage and adolescent pregnancy. School retention of girls should be monitored, therefore contributing towards gender parity in education.

Illuminating the transitional habitus of the early career health science professional as postgraduate supervisor.

BACKGROUND: Early career health science professionals often find themselves in a transitional space when moving from a health science professional role to academia. The role of a postgraduate supervisor is especially troublesome. Transitional spaces often bring uncertainty and perceived or real threats, fear, worry, anxiety and stress. Without support, the result could be detrimental to the mental health of the early career as postgraduate supervisors, thereby impacting their professional identity formation. AIM: To understand the underlying elements that shaped the early career health science professional as postgraduate supervisors' habitus and how these features play out in their postgraduate supervision practice. SETTING: The research study was carried out at an Open and Distance e-Learning University (ODeL) and a residential university. METHODS: Visual elicitation methods in the form of seven drawings were used as data. Pierre Bourdieu's concepts of habitus and hexis were used as a theoretical lens, and structural analysis with analytical memoing was used to interrogate the drawings. RESULTS: Early career health science professional as postgraduate supervisors' bodily habitus presented as fragmented or yet to be formed along with other entanglements, such as emotions, language, power and material arrangements. CONCLUSION: These features enable policymakers, employee assistance practitioners, educational developers and experienced academics to consider the changes and structural forces that need to be addressed to support early career health science professional as postgraduate supervisors. CONTRIBUTION: A creative means of exploring the inner world of the early career health science professional as postgraduate supervisors is undertaken. In doing so, the research article potentially illuminates what has up to now been 'unsaid'.

Experience of nurses regarding the clinical mentoring of student nurses in resource-limited settings.

BACKGROUND: One of the major challenges associated with nursing education in this 21st century is the practice preparation of student nurses to serve in complex healthcare environments and to ensure their fitness to practise in these environments. Clinical mentoring has shown promise in providing clinical learning support for student nurses. Most approaches are, however, biased towards higher-income settings without giving due consideration to the resources, culture and structures of health systems in resource-limited settings. It is also unclear how qualified nurses who act as nurse teachers experience the clinical mentoring of student nurses in resource-limited settings. AIM: This study aimed to explore and describe the experiences of qualified nurses regarding the clinical mentoring of nursing students in resource-limited settings. SETTING: The study took place in Mauritius, a developing country. METHODS: A qualitative, exploratory, descriptive approach was used with a purposive sample of eight nurses. Data were collected through face-to-face interviews and thematically analysed. RESULTS: The findings indicated that mentoring per se was not practised, but rather general support, supervision or coaching. This resulted in the practice being less effective for its original purpose. Possible explanations included a lack of policy directives. Additionally, the mentoring practice was informal with unclear role expectations. Poor material and personal resources further compounded the challenges. An absence of buy-in and involvement of management along with a lack of monitoring clinical mentoring by the nursing school concludes the picture. CONCLUSION: Effective clinical mentoring requires an understanding of the mentoring process from a broader perspective. Mentors should be equipped with core competencies. Successful mentoring outcomes are dependent on a conducive clinical learning environment and a clear mentoring approach.

Self-managing individual wellness for the health professional: A somatology perspective.

BACKGROUND: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. AIM: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. SETTING: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. METHOD: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. RESULTS: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. CONCLUSIONS: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness.

Family caregivers for adult cancer patients: knowledge and self-efficacy for pain management in a resource-limited setting.

Adult cancer patients (ACPs) in resource-limited settings disproportionately suffer from inadequate pain control despite advancements in pain management. Family caregivers (FCGs) can support optimal pain control for ACPs in these settings if they are knowledgeable and confident about the needed care. However, the status of FCGs' knowledge and self-efficacy (SE) for pain management in developing countries is not well established. PURPOSE: To assess the FCGs' knowledge and SE levels for pain management among ACPs while at home in a resource-limited setting. METHODS: Using a questionnaire that comprised a Family Pain Questionnaire and Chronic Pain Self-efficacy Scale, data were collected from 284 FCGs of ACPs receiving care from two cancer care centres. RESULTS: The FCGs had moderate knowledge (mean = 41.70 ± 14.1) and SE (mean = 795.95 ± 301.3) levels for pain management at home for ACPs. Majority of the FCGs had low knowledge (52.1%), but expressed higher SE (52.5%). Poor self-rated health among FCGs was significantly associated with low knowledge levels (OR = 1.75; 95% CI 1.024-2.978, p = 0.041). SE was significantly associated with perceiving a low impact of caregiving on health (OR = 1.55; 95% CI 1.074-2.239, p = 0.019), hours of caregiving per week (OR = 0.52; 95% CI 0.315-0.854; p = 0.01) and receiving organisational support (OR = 0.388; 95% CI 0.222-0.679; p = 0.001). CONCLUSION: The results show a need for deliberate interventions to enhance FCG knowledge and SE for pain management at home as one of the ways of improving cancer pain management in resource-limited settings.

Self-managing individual wellness for the health professional: a somatology perspective

Background: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. Aim: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. Setting: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. Method: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. Results: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. Conclusions: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness

Recognition of prior learning candidates' experiences in a nurse training programme.

Recognition of prior learning (RPL) in South Africa is critical to the development of an equitable education and training system. Historically, nursing has been known as one of the professions that provides access to the training and education of marginalised groups who have minimal access to formal education. The advent of implementing RPL in nursing has, however, not been without challenges. The purpose of this study was to explore and describe the experiences of RPL nursing candidates related to a 4-year comprehensive nursing training programme at a nursing education institution in Gauteng. An exploratory, descriptive and contextual qualitative research design was undertaken. The research sample comprised 13 purposefully selected participants. Face-to-face individual interviews, using open-ended questions, were used to collect data, which were analysed using Tesch's approach. Recognition of prior learning candidates experienced a number of realities as adult learners. On a positive note, their prior knowledge and experience supported them in their learning endeavours. Participants, however, experienced a number of challenges on personal, interpersonal and socialisation, and educational levels. It is important that opportunities are created to support and assist RPL candidates to complete their nursing training. This support structure, among others, should include the provision of RPL-related information, giving appropriate advice, coaching and mentoring, effective administration services, integrated curriculum design, and a variety of formative and summative assessment practices.

Facilitating the development of higher-order thinking skills (HOTS) of novice nursing postgraduates in Africa.

BACKGROUND: International research in nursing education has shown to be deficient regarding both the quality of research produced and the building of disciplinary capacity. The CHENMA (Collaboration for Higher Education of Nurses and Midwives in Africa) project aimed to strengthen nursing and midwifery expertise in Africa. Sixteen French-speaking students of the Democratic Republic of the Congo (DRC) enrolled for a master's degree in nursing midwifery at a South African university in 2008. Ten of the initial 16 students graduated with a master's degree in 2012. One student withdrew and five students completed a postgraduate diploma in midwifery. OBJECTIVES: The objective of this paper is to explore the quality of the output of those master's degree students, namely their dissertation (with specific reference to the demonstration of HOTS). METHODS: An exploratory, evaluative, single, descriptive case study was utilised. Realist, purposeful sampling was used. Six of the 10 completed final dissertations were evaluated as well as three reflective reports from the supervisor, translator and critical reader. RESULTS: The findings indicated that most dissertations fell below the expected standard, with a paucity of higher-order thinking and application skills. Language, and possibly cultural dynamics, seemed to be the largest barrier to learning and communication. The dissertations lacked conceptual skills, scientific writing skills, logical order of thought and congruency. Analysis of the dissertations revealed a limited ability of novice scholars to explore the nature of information and to interpret and manipulate the data in a novel way.